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Stimulant Use Disorder: Amphetamine Type (e.g., methamphetamine)

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

The diagnostic criteria for a substance use disorders were previously reviewed. These criteria apply to amphetamine use disorders.

Amphetamines are stimulant drugs. The most commonly known drug in this class is methamphetamine or "crystal meth" (also known as crank). Other amphetamine drugs include dextroamphetamine, and appetite suppressants. Street names are speed, bennies, black beauties, and dexies. People take these drugs orally, intravenously, or nasally. In some cases they are smoked. People obtain prescriptions for amphetamines for conditions such as obesity, narcolepsy, and attention-deficit/hyperactivity disorder. When people use a drug correctly, as prescribed, this does not meet the diagnostic criteria for a substance use disorder. However, if someone exceeds the prescribed dose and frequency, then a diagnosis of amphetamine use disorder may be used. This is true even though a person has a prescription. Tolerance and withdrawal symptoms can develop for amphetamine.

Amphetamine use disorders are not limited to any one group of people. However, these diagnoses are more common in men.

Use may be either chronic or episodic. Chronic use refers to continued use without periods of abstinence. Episodic use refers to periods of heavy use, followed by periods reduced use, or abstinence. A common pattern of episodic use is heavy and continuous use during weekends. Then, once the workweek begins, people reduce or discontinue their use. Sometimes people who abuse drugs in this manner are termed functional addicts, (or functional alcoholics).

Severe forms of amphetamine addiction may lead to significant weight loss, anemia, and poor health due to a lack of personal hygiene. In some cases, skin-picking can develop. This leads to severe infections. Skin-picking occurs because amphetamine use causes dry skin and itchiness. It may also result from amphetamine-induced psychosis. This occurs when a person hallucinates that there are bugs crawling just below the surface of the skin.

Stimulant Withdrawal

After prolonged and heavy use of stimulants, withdrawal may occur after cessation or significant reduction in drug use. Stimulant withdrawal usually begins within a few hours to several days after the last use. It often includes symptoms of depressed mood; fatigue; vivid dreams; sleep difficulties; increased appetite; psychomotor slowing or agitation; and powerful cravings. In some cases, suicidal ideation may also be present.

While stimulant withdrawal is uncomfortable, it does not usually require medical monitoring. However, because of the increased risk for suicide, clinicians should evaluate suicide risk and monitor patients accordingly.

Effects of Stimulants: Intoxication

Stimulant intoxication produces feelings of euphoria, well-being, and confidence. Dramatic changes in behavior and mood disturbances also occur. People may become highly paranoid, anxious, irritable, angry, or depressed. In addition dramatic mood swings can occur. People may exhibit poor judgment and aggression. In more severe cases, people may become delusional and/or experience tactile or auditory hallucinations. Hyper-vigilance, hyper-activity, confusion, and talkativeness are also common. Likewise, people may engage in indiscriminate or dangerous sexual liaisons.

Physical changes include pupil dilation; altered body temperature; nausea or vomiting; weight loss; psychomotor changes; muscular weakness; chest pain; confusion; and elevated or lowered blood pressure (different people have different reactions). The acute physical symptoms generally develop within an hour. The severity of the symptoms depends on the dose taken; however, death due to overdose is rare. Nonetheless, if someone has received a high dose, medical attention is advisable. Sudden death, seizures, coma, and stroke can occur in otherwise healthy people due to the drug's effect on the cardio-vascular system.


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